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DAVID THUNDER: The cure for Covid-19 may be worse than the disease

Ireland has been slower than most other EU countries to re-open its borders to inward travel. A certain narrative is taking root, endorsed by prominent voices in the scientific community as well as in Dáil Éireann, to the effect that we should spare no effort in keeping Ireland “Covid-free.” 

This narrative has radicalized our thinking around Covid-19, by insinuating that any approach liable to increase the risk of transmission of SARS-CoV-2, however marginally, is self-evidently reckless, irresponsible, or unpatriotic.

But this way of thinking is unduly simplistic.

First of all, like it or not, the SARS-CoV-2 virus, which has proved resistant to prolonged lockdowns, is already in circulation both domestically and across the world, and is almost certainly here to stay for years to come. Indeed, according to government estimates, approximately 88% of reported cases are homegrown. So tough border quarantines would have a limited impact on the spread of the virus.

Furthermore, the sorts of interventions required to suppress this virus, from blanket travel quarantines to national lockdowns, are likely to inflict disproportionate collateral damage on our health and well-being.

Some have claimed that a concerted effort to make Ireland a “Covid-free” island will be economically beneficial. Yet in reality, doing everything required to suppress the virus would have dire consequences for those whose livelihoods depend directly or indirectly on our tourism industry, and those whose mental and physical health is jeopardised by economic hardship and prolonged lockdowns.

Many people have suffered lonely and painful deaths at the hands of Covid-19. We should do everything we reasonably can to prevent this from happening again. But we must also act proportionately, using targeted interventions whose unintended effects are not catastrophic for human health and well-being.

Unfortunately, there is no scientific consensus on the true lethality of Covid-19. Estimates of its infection fatality rate (IFR) vary dramatically, from as low as 0.2% to as high as 1%. Available clinical evidence does suggest, however, that the risk of suffering a severe disease through Covid-19 infection is very low for those under 65 without underlying health conditions.

The risk for children is close to zero, while the risk is significantly higher for the elderly and those suffering from certain chronic conditions such as diabetes, hypertension, and immunodeficiency.

Keeping this risk distribution in mind, we need to expand the capacity of our health system and responsibly adapt our laws and customs to cope as best we can. Social distancing measures can help reduce the infection rate. It is especially critical that we develop strategies to protect high risk populations such as the elderly and especially those in care homes.

However, eliminating Covid risk would require some extremely costly measures such as economically devastating lockdowns and tourist quarantines. Indeed, the costs of bringing Covid-19 risk down to zero may well make the cure worse than the disease.

Of course, we should take reasonable steps to mitigate risks posed by this virus to health and well-being. But if we wish to live free and functional human lives, we must also learn to live with some level of risk.

There are a range of goods that we could not enjoy in the absence of risk. For example, nobody in his right mind would suggest that we should shut down all chocolate factories to combat diabetes and obesity; and there would be uproar if a government attempted to impose a society-wide curfew in peace times just because many muggings occur at night.

It is imperative that we find ways to manage Covid risk that are not excessively destructive to our economy and well-being. We need to balance competing goods, giving due weight both to the objective risks associated with SARS-CoV-2 infections, and other values worth protecting, such as close family relationships, psychological health, child development, education, and sustainable economic development.

Several governments severely under-estimated the risk Covid-19 posed to care homes, tragically paving the way for over a half of all Covid-19 deaths.

But to the extent that the public imagination is saturated with Covid-19 stories, there is now a real danger of overestimating the risk of Covid-19 in the general population, much as endless media coverage of terror attacks gives the impression that a terrorist is lurking around every corner.

Fear is visceral when an unknown disease spreads fast and claims many victims unexpectedly. But that fear may lead us to act irrationally, by treating a single infectious disease as the only relevant evil policymakers need to be mindful of.

An overly zealous approach to managing Covid risk would license our government to impose draconian measures such as lockdowns and indiscriminate visitor quarantines, whose unintended effects would likely include the paralysis of our tourism industry, the devastation of our economy, and the withdrawal of critical funding from an already dysfunctional health service.

Like it or not, we will have to learn to live alongside some measure of Covid-19 risk as we gradually open up our economy and rebuild our lives. The sooner we accept that, the sooner we will be in a position to develop a realistic, balanced, and economically sustainable plan for coping with future waves of this elusive virus.

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